NPIMap

Organization Active NPI

Oral and Facial Surgery Associates, PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Lawrenceville, GA
National Provider Identifier
1699780163
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
DN009242 Issued in GA
Legal business name
ORAL AND FACIAL SURGERY ASSOCIATES, PC
Practice address
745 Old Norcross Rd
Lawrenceville, GA 30045-4317
Phone
(770) 962-9515
Fax
(770) 962-2722
NPI assigned
Jul 30, 2006
Last updated
Apr 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert E Ellis, DDSNPI 1053320028
Title
Managing Partner
Phone
(770) 962-9515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X DN009242 GA Primary

Addresses

Primary practice location

745 Old Norcross Rd
Lawrenceville, GA 30045-4317

Mailing address

745 Old Norcross Rd
Lawrenceville, GA 30045-4317
Phone (770) 962-9515

Other practice location 1

4470 Commerce Dr Ste A
Buford, GA 30518-7510
Phone (678) 714-5109

Other practice location 2

1215 Tuscany Dr Ste A
Braselton, GA 30517-3488
Phone (770) 962-2226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041108000923 GA Part B Supplier - Clinic/Group Practice 4082677380 Receives reassigned benefits from 3 practitioners
Practice locations: Braselton, GA; Lawrenceville, GA; Buford, GA

National Provider Directory

National Provider Directory

Locations

4470 Commerce Dr
Ste A
Buford, GA 30518
Phone (678) 714-5109

745 Old Norcross Rd
Lawrenceville, GA 30046
Phone (770) 962-9515

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1699780163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300454317",
            "telephone_number": "770-962-9515",
            "fax_number": "770-962-2722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300454317",
            "telephone_number": "770-962-9515",
            "fax_number": "770-962-2722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4470 Commerce Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Buford",
            "state": "GA",
            "postal_code": "305187510",
            "country_code": "US",
            "telephone_number": "678-714-5109",
            "fax_number": "770-962-2250",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1215 Tuscany Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305173488",
            "country_code": "US",
            "telephone_number": "770-962-2226",
            "fax_number": "678-975-7862",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORAL AND FACIAL SURGERY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "770-962-9515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "GA",
            "license": "DN009242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.